（嘈症附）
经云∶二阳结谓之消。二阳者，手足阳明也。手阳明大汤主津病，消则目黄口干，是津
不足也。足阳明胃主血，热则消谷善饥，是血中挟火，血不足也。未传能食，必发痈疽，不能
食，必传如胀满，皆不治，经云∶饮食入胃，精气输脾。又脾与胃膜相连，又脾主为胃行其津
液。脾属阴，主血，胃属阳，主气。胃易燥，全赖脾阴以和之。脾易湿，必赖胃阳以运之。故
一阴一阳合冲和之气，而为后天生化之源也。若脾阴虚，则胃家游溢之精气全输于脾，不能
稍留津液以自润，则胃过于燥而有火矣。故急欲得食以自资，迟则嘈杂尤甚。若失治则必延成消膈之症。
上消肺因心移热，二便如常饮水适。中消胃热食偏多，大便硬坚小便赤。下消肾热渴饮
汤，耳叶焦干便淋沥，虽分肺胃肾三般，总是肾水不足得。肾水不足虚火炎，津液干枯血虚
极。地黄饮子六味丸，清息用之定有益。
郁火致消（善饥而渴目加瘪，心郁火燃当清阳明之热，以滋少阴）
生地 麦冬 生白芍 石膏 知母 西甘草
朱丹溪消渴方 生地 花粉 川连 藕汁 牛乳
烦劳心营热（肌瘦饥渴，是上中二消病）
乌犀角 元参 沙参 地骨皮 鲜生地 麦冬 柿霜 生甘草
又 固本丸加人参
肝阳犯胃成消
石膏 生地 生白芍 人参 川斛 粳米 阿胶 知母 生甘草 麦冬 陈皮 佩兰
元阳变动，烁津成消（此甘缓和阳生津法）
河间甘露饮 炙黑草 生白芍 生地 麦冬 知母 生枣仁
肾消（饥渴便浑，舌碎面赤，是阴虚阳气上燔）
六味丸加牛膝 车前 补足三阴
肾阴虚，胃火胀成消（脉左数能食）
六味丸加天冬 麦冬 龟版 女贞子 川萆 旱莲
肾阴虚，心火亢（形瘦脉搏，渴饮善食，三消症也）
陈曰∶古人谓入水无物不长，入火无物不消。河间每以益肾水、制心火、除肠胃燥热、济
身中液枯是真治法。用玉女煎。三消症虽有上中下之分，其实不外阴亏阳亢，津液枯涸，
热淫而已。当以仲景之肾气丸、《本事方》之神效散为主。肾气丸助真火蒸化，升津液，上承
神效散，取水中咸寒之物，遂其性而治之。方用白海浮石、蛤壳粉、蝉退为末，以大鲫鱼七个，捣烂调服。
肾消两腿渐细，腰足无力，此因中消之后，胃热入肾，销烁肾脂，令肾枯槁，溲如膏
脂。晋人云∶肺主气，肺无病则气能管束精液。其精微者营养筋骨血脉。余者为溲。肺病则
津液无气管束，而精微者亦随溲下如膏脂也。
白茯苓丸
茯苓 元参 人参 川萆 覆盆子 熟地 川连 川斛 蛇床子
白蜜为丸，磁石汤下。
附嘈症
嘈有虚实真伪，其病总在于胃。胃过于燥则火升，而嘈得食可止。久延便变消渴症。
阳升嘈杂
生地 柏子仁 茯神 麦冬 料豆皮 川斛
心肠热嘈，必烦热头汗
淮小麦 茯神 南枣 柏子仁 炙草 辰砂
血虚嘈杂（兼咽疮）
生地 麦冬 生白芍 炙草 天冬 女贞 火麻仁 茯神
肝阴虚发嘈（妇人半日一发，夜则更甚）
生地 清阿胶 茯神 天冬 紫丹参 白芍
陈参曰∶脾阴虚则胃燥而有火矣。治当补脾阴，养营血，兼补胃阴，甘凉濡润，稍佐微酸。
（嘈杂症附）
《内经》说：二阳（手阳明大肠经和足阳明胃经）气机郁结就会发生消渴病。所谓二阳，指的是手阳明大肠经和足阳明胃经。手阳明大肠经主管津液，若病变则出现目黄、口干，这是津液不足的表现。足阳明胃经主管血液，若有热邪则消化食物过快而容易饥饿，这是血中夹杂火邪，导致血不足的表现。如果病情未传变，患者能进食，必定会发痈疽；如果不能进食，必定传变为胀满之症，这些都属于难治之症。《内经》又说：饮食进入胃中，其精微物质输送给脾脏。另外，脾与胃通过膜相连，且脾主为胃传输津液。脾属阴，主血；胃属阳，主气。胃容易干燥，完全依赖脾阴来调和它；脾容易湿滞，必须依赖胃阳来运化它。所以一阴一阳冲和之气结合，成为后天生命活动的生化之源。如果脾阴虚，那么胃中游溢的精气全部输送到脾，不能稍微留存津液来自我滋润，就会导致胃过于干燥而生火。因此患者急切想要进食以自我滋养，稍晚一点嘈杂感就会更加严重。如果延误治疗，必定延宕成膈噎（吞咽困难）之症。
上消：肺因心移热所致，大小便正常，只是饮水多。
中消：胃热炽盛，食欲偏多，大便干硬，小便色赤。
下消：肾热导致口渴饮水，耳廓焦干，小便淋漓不尽。
虽然分为肺、胃、肾三处病变，但根本原因总是肾水不足。肾水不足导致虚火上炎，津液干枯，血虚到了极点。地黄饮子和六味丸（由熟地黄、山茱萸、山药、泽泻、牡丹皮、茯苓组成），清热平息虚火使用它们一定有益。
郁火导致消渴（症状为善饥且渴，目眶凹陷，心火郁结燃烧，应当清泄阳明之热，以滋补肾阴）
处方：生地黄、麦冬、生白芍、石膏、知母、西甘草。
朱丹溪的消渴方：生地黄、天花粉、黄连、藕汁、牛乳。
烦劳导致心营热（肌肉消瘦，饥渴，这是上消和中消的病证）
处方：乌犀角、玄参、沙参、地骨皮、鲜生地、麦冬、柿霜、生甘草。
又方：固本丸加入人参。
肝阳侵犯胃导致消渴
处方：石膏、生地黄、生白芍、人参、川石斛、粳米、阿胶、知母、生甘草、麦冬、陈皮、佩兰。
元阳变动，灼伤津液导致消渴（这是甘缓和阳、生津的方法）
河间甘露饮：炙黑甘草、生白芍、生地黄、麦冬、知母、生酸枣仁。
肾消（饥渴，小便浑浊，舌面破碎，面色红赤，这是阴虚阳气上燔）
六味丸加牛膝、车前子，补足三阴经。
肾阴虚，胃火胀导致消渴（脉象左部数，能进食）
六味丸加天冬、麦冬、龟版、女贞子、川萆薢、旱莲草。
肾阴虚，心火亢盛（形体消瘦，脉搏快，口渴饮水，善于进食，是三消症）
陈氏说：古人说入水没有东西不生长，入火没有东西不消解。刘河间常常用益肾水、制心火、除肠胃燥热、济身中液枯的方法，这才是真正的治法。使用玉女煎。三消症虽然有上、中、下的区分，其实无非是阴亏阳亢，津液枯涸，热邪淫盛罢了。应当以张仲景的肾气丸、《本事方》的神效散为主。肾气丸助真火蒸腾气化，升提津液，上承于口；神效散，取水中咸寒之物，顺其本性而治疗。方用白海浮石、蛤壳粉、蝉蜕研为末，用大鲫鱼七条，捣烂调服。
肾消导致两腿逐渐变细，腰足无力，这是因为中消之后，胃热传入肾脏，销烁肾脂，令肾枯竭，小便像膏脂一样。晋代医家说：肺主气，肺没有病则气能管束精液。其中精微的部分营养筋骨血脉，其余部分变成尿液。肺有病则津液失去气的管束，而精微部分也随着尿液下行，像膏脂一样。
白茯苓丸：茯苓、玄参、人参、川萆薢、覆盆子、熟地黄、黄连、川石斛、蛇床子。
用白蜜制成丸药，磁石汤送服。
附嘈杂症
嘈杂有虚、实、真、伪之分，其病总在于胃。胃过于干燥则火气上升，而嘈杂在进食后可以停止。久延便会变成消渴症。
心肠热嘈，必然伴有烦热、头汗
处方：淮小麦、茯神、南枣、柏子仁、炙甘草、辰砂。
血虚嘈杂（兼有咽疮）
处方：生地黄、麦冬、生白芍、炙甘草、天冬、女贞子、火麻仁、茯神。
(Attached: Zao Re Syndrome)
The *Classic of Internal Medicine* states: "Stagnation in the Two Yangs is called Xiao (Wasting and Thirst)." The Two Yangs refer to the Hand-Yangming Large Intestine Meridian and the Foot-Yangming Stomach Meridian. The Hand-Yangming Large Intestine Meridian governs Jin Ye (Body Fluids); when diseased, it presents with yellow eyes and dry mouth, indicating a deficiency of Jin Ye. The Foot-Yangming Stomach Meridian governs Blood; when heat is present, it causes rapid digestion and easy hunger, indicating that Fire is mixed within the Blood, leading to Blood deficiency. If the condition has not transmitted, the patient can eat but will inevitably develop carbuncles and sores; if they cannot eat, it will inevitably transmit to distension and fullness, both of which are difficult to treat. The *Classic* also states: "When food enters the Stomach, its essence is transported to the Spleen." Furthermore, the Spleen and Stomach are connected by membranes, and the Spleen is responsible for transporting Jin Ye on behalf of the Stomach. The Spleen belongs to Yin and governs Blood; the Stomach belongs to Yang and governs Qi. The Stomach tends toward dryness and relies entirely on Spleen Yin to harmonize it. The Spleen tends toward dampness and must rely on Stomach Yang to transform it. Thus, the harmonious Qi of one Yin and one Yang combines to become the source of postnatal transformation. If Spleen Yin is deficient, then all the overflowing essence from the Stomach is transported to the Spleen, unable to retain any Jin Ye to moisten itself, causing the Stomach to become overly dry and generate Fire. Therefore, the patient urgently desires food to nourish themselves; if delayed, the Zao Re (burning sensation in the stomach) becomes even more severe. If treatment is neglected, it will inevitably prolong into Ge Ge (Dysphagia/Regurgitation) syndrome.
Upper Xiao: Lung affected by Heart transferring heat; urination and defecation are normal, only excessive drinking occurs.
Middle Xiao: Stomach Heat causes increased appetite; stool is hard and firm, urine is red.
Lower Xiao: Kidney Heat causes thirst and drinking; earlobes are dry and scorched, urination is dribbling.
Although divided into Lung, Stomach, and Kidney, the root cause is always insufficient Kidney Water. Insufficient Kidney Water leads to deficient Fire flaming upward, dryness of Jin Ye, and extreme Blood deficiency. Di Huang Yin Zi (Rehmannia Decoction) and Liu Wei Wan (Six-Ingredient Pill with Rehmannia), used to clear heat and extinguish fire, will certainly be beneficial.
Xiao caused by Depressed Fire (Symptoms: easy hunger and thirst, sunken eyes; Heart Fire is depressed and burning, should clear Yangming Heat to nourish Shaoyin [Kidney])
Prescription: Sheng Di Huang (Raw Rehmanniae Radix), Mai Dong (Ophiopogonis Tuber), Sheng Bai Shao (Raw Paeoniae Radix Alba), Shi Gao (Gypsum Fibrosum), Zhi Mu (Anemarrhenae Rhizoma), Xi Gan Cao (Western Licorice Root).
Zhu Danxi's Xiao Ke Fang (Wasting-Thirst Formula): Sheng Di Huang, Hua Fen (Trichosanthis Radix), Chuan Lian (Coptidis Rhizoma - Note: likely meant Huang Lian/Coptidis Rhizoma based on context, but text says Chuan Lian which usually refers to Cnidium or Corydalis, however in Xiao Ke formulas Huang Lian is standard. Given "Chuan Lian" appears elsewhere as distinct, here strictly translating text: Chuan Lian), Ou Zhi (Lotus Root Juice), Niu Ru (Cow Milk).
Heat in Ying (Nutritive) Level due to Overwork (Muscle emaciation, hunger and thirst; this is Upper and Middle Xiao disease)
Prescription: Wu Xi Jiao (Black Rhinoceros Horn - substitute with Buffalo Horn in modern practice), Xuan Shen (Scrophulariae Radix), Sha Shen (Glehniae Radix), Di Gu Pi (Lycii Cortex), Xian Sheng Di Huang (Fresh Raw Rehmanniae Radix), Mai Dong, Shi Shuang (Persimmon Frost), Sheng Gan Cao.
Another prescription: Gu Ben Wan (Solidify the Root Pill) added with Ren Shen (Ginseng Radix).
Liver Yang invading Stomach causing Xiao
Prescription: Shi Gao, Sheng Di Huang, Sheng Bai Shao, Ren Shen, Chuan Hu (Dendrobii Caulis), Jing Mi (Glucinis Semen), E Jiao (Donkey-Hide Glue), Zhi Mu, Sheng Gan Cao, Mai Dong, Chen Pi (Citri Reticulatae Pericarpium), Pei Lan (Eupatorii Herba).
Movement of Yuan Yang, scorching Jin Ye causing Xiao (This is a method of sweet neutrality to harmonize Yang and generate Jin Ye)
He Jian's Gan Lu Yin (Sweet Dew Decoction): Zhi Hei Cao (Charred Black Licorice Root), Sheng Bai Shao, Sheng Di Huang, Mai Dong, Zhi Mu, Sheng Zao Ren (Raw Ziziphus Seed).
Kidney Xiao (Hunger and thirst, turbid urine, cracked tongue, red face; this is Yin deficiency with Yang flaming upward)
Liu Wei Wan added with Niu Xi (Achyranthis Bidentatae Radix) and Che Qian (Plantaginis Semen), tonifying the Three Yin meridians.
Kidney Yin deficiency, Stomach Fire distension causing Xiao (Pulse rapid on the left, able to eat)
Liu Wei Wan added with Tian Dong (Asparagi Radix), Mai Dong, Gui Ban (Testudinis Carapax et Plastrum), Nv Zhen Zi (Ligustri Lucidi Fructus), Chuan Bi (Bistortis Rhizoma), Han Lian Cao (Ecliptae Herba).
Kidney Yin deficiency, Heart Fire hyperactivity (Emaciated form, rapid pulse, thirst and drinking, good appetite; this is San Xiao [Three Wastes])
Chen said: The ancients said that in water nothing does not grow, in fire nothing does not consume. He Jian often used methods to benefit Kidney Water, restrain Heart Fire, eliminate dryness-heat in the intestines and stomach, and relieve the dryness of body fluids; this is the true treatment method. Use Yu Nu Jian (Jade Woman Decoction). Although San Xiao is divided into Upper, Middle, and Lower, it is essentially merely Yin deficiency with Yang hyperactivity, dryness of Jin Ye, and excess Heat. One should primarily use Zhang Zhongjing's Shen Qi Wan (Kidney Qi Pill) and the *Ben Shi Fang*'s Shen Xiao San (Miraculous Effect Powder). Shen Qi Wan assists True Fire to vaporize and transform, raising Jin Ye to ascend; Shen Xiao San takes salty-cold substances from water, following their nature to treat the condition. The formula uses Bai Hai Fu Shi (Pumex), Ge Qiao Fen (Clam Shell Powder), Chan Tui (Cicada Slough) ground into powder, taken mixed with seven large crucian carp pounded into a paste.
Kidney Xiao causing gradual thinning of both legs and weakness in waist and feet; this is because after Middle Xiao, Stomach Heat enters the Kidney, consuming Kidney Fat, causing the Kidney to wither, and urine resembling fat. Jin dynasty physicians said: The Lung governs Qi; if the Lung is healthy, Qi can control and bind Jing Ye (Essence and Fluids). Its refined parts nourish sinews, bones, blood, and vessels; the remainder becomes urine. If the Lung is diseased, Jin Ye loses Qi control, and the refined parts descend with urine like fat.
Bai Fu Ling Wan (White Poria Pill): Fu Ling (Poria), Xuan Shen, Ren Shen, Chuan Bi, Fu Pen Zi (Rubi Fructus), Shu Di Huang (Prepared Rehmanniae Radix), Chuan Lian, Chuan Hu, She Chuang Zi (Cnidii Fructus).
Made into pills with Bai Mi (White Honey), taken down with Ci Shi Tang (Magnetite Decoction).
Attached: Zao Re Syndrome
Zao Re has deficiency, excess, true, and false types; its pathology always lies in the Stomach. If the Stomach is overly dry, Fire rises, and Zao Re stops after eating. Prolonged, it transforms into Xiao Ke syndrome.
Yang Rising Zao Re
Prescription: Sheng Di Huang, Bai Zi Ren (Biota Seed), Fu Shen (Poria with Hostwood), Mai Dong, Dou Pi (Vigna Angularis Peel), Chuan Hu.
Heart and Intestine Heat Zao Re, necessarily accompanied by irritability, heat, and head sweating
Prescription: Huai Xiao Mai (Triticum Vulgare), Fu Shen, Nan Zao (Chinese Date), Bai Zi Ren, Zhi Cao (Licorice Root), Chen Sha (Cinnabar).
Blood Deficiency Zao Re (accompanied by throat ulcers)
Prescription: Sheng Di Huang, Mai Dong, Sheng Bai Shao, Zhi Cao, Tian Dong, Nv Zhen, Huo Ma Ren (Hemp Seed), Fu Shen.
Liver Yin Deficiency Zao Re (Women suffer attacks every half day, worse at night)
Prescription: Sheng Di Huang, Qing E Jiao (Clear Donkey-Hide Glue), Fu Shen, Tian Dong, Zi Dan Shen (Red Sage Root), Bai Shao.
Chen Can said: If Spleen Yin is deficient, the Stomach becomes dry and generates Fire. Treatment should tonify Spleen Yin, nourish Ying Blood, and simultaneously tonify Stomach Yin, using sweet-cool moistening methods, slightly assisted by mild sour flavors.